Ending Preventable Child Death in a Generation

DURING THE PAST 20 YEARS, THERE HAS BEEN A SUBstantial decline in mortality among children younger than 5 years from 12.0 million deaths in 1990 to 7.6 million in 2010. In these decades alone, global health and development efforts have saved the lives of more than 50 million children, half of them by preventing deaths due to pneumonia, diarrhea, and measles. This improvement in child survival was catalyzed in part by setting aspirational global targets such as the Millennium Development Goals (MDGs). As 2015 approaches, and with it a final assessment of progress toward MDG 4 on reducing child mortality, it is appropriate to consider a post-2015 vision for child health. A new common vision for a global commitment to end all preventable child deaths is needed. Such a vision will not be compelling unless it can be tied to concrete and measurable benchmarks at the global and country levels that are both ambitious and plausible. In this Viewpoint, a new benchmark is detailed: that all countries achieve a national under-5 mortality rate (U5MR) of no more than 20 deaths per 1000 live births by 2035 and that the global average U5MR should decline to 15 deaths per 1000 in 2035. Of 195 countries, 98 already have U5MRs of 20 per 1000 or fewer; 43 countries would be expected to reach this goal by 2035 at current annual rates of reduction (ARRs), and 54 countries would have to accelerate progress above the 2000-2010 ARRs. The proposed U5MR benchmark of 20 deaths per 1000 live births is supported by modeling analyses by UNICEF as well as ...